528 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS◗ SUMMARY OFNURSINGINTERVENTIONS FORDEMENTIA
- Promoting client’s safety and protecting from injury
Offer unobtrusive assistance with or supervision of cooking, bathing, or self-care activities.
Identify environmental triggers to help client avoid them. - Promoting adequate sleep, proper nutrition and hygiene, and activity
Prepare desirable foods and foods client can self-feed; sit with client while eating.
Monitor bowel elimination patterns; intervene with fluids and fiber or prompts.
Remind client to urinate; provide pads or diapers as needed, checking and changing them frequently to avoid
infection, skin irritation, unpleasant odors.
Encourage mild physical activity such as walking. - Structuring environment and routine
Encourage client to follow regular routine and habits of bathing and dressing rather than impose new ones.
Monitor amount of environmental stimulation, and adjust when needed. - Providing emotional support
Be kind, respectful, calm, and reassuring; pay attention to client.
Use supportive touch when appropriate. - Promoting interaction and involvement
Plan activities geared to client’s interests and abilities.
Reminisce with client about the past.
If client is nonverbal, remain alert to nonverbal behavior.
Employ techniques of distraction, time away, going along, or reframing to calm clients who are agitated,
suspicious, or confused.
and other people, and validating feelings and dignity
of clients by being responsive to them, offering choices,
and reframing(technique in which the nurse offers
alternative points of view to explain events) (Finnema
et al., 2000). This is in contrast to medical models
of care that focus on progressive loss of function and
identity.
Nurses can use the following interventions in
any setting for clients with dementia. Education for
family members caring for clients at home and for
professional caregivers in residential or skilled facil-
ities is an essential component of providing safe and
supportive care. The discussion provides examples
that apply to various settings.
PROMOTING THE CLIENT’S SAFETY
Safety considerations involve protecting against in-
jury, meeting physiologic needs, and managing risks
posed by the environment including internal stimuli
such as delusions and hallucinations. Clients cannot
accurately appraise the environment and their abil-
ities; therefore, they do not exercise normal caution
in daily life. For example, the client living at home
may forget food cooking on the stove; the client liv-
ing in a residential care setting may leave for a walk
in cold weather without a coat and gloves. Assis-
tance or supervision that is as unobtrusive as pos-
sible protects clients from injury while preserving
their dignity.
A family member might say, “I’ll sit in the kitchen
and talk to you while you make lunch”(suggesting col-
laboration) rather than, “You can’t cook by yourself
because you might set the house on fire.”In this way,
the nurse or caregiver supports the client’s desire and
ability to engage in certain tasks while providing pro-
tection from injury.
Clients with dementia may believe that their
physical safety is jeopardized; they may feel threat-
ened or suspicious and paranoid. These feelings can
lead to agitated or erratic behavior that compromises
safety. Avoiding direct confrontation of the client’s
fears is important. Clients with dementia may strug-
gle with fears and suspicion throughout their illness.
Triggers of suspicion include strangers, changes in
the daily routine, or impaired memory. The nurse
must discover and address these environmental trig-
gers rather than confront the paranoid ideas.
For example, a client reports that his belongings
have been stolen. The nurse might say, “Let’s go look
in your room and see what’s there”and help the client
to locate the misplaced or hidden items (suggesting
collaboration). If the client is in a room with other
people and says, “They’re here to take me away!”the
nurse might say, “Those people are here visiting with
someone else. Let’s go for a walk and let them visit”
(presenting reality/distraction). The nurse then can
take the client to a quieter and less stimulating place,
which moves the client away from the environmental
trigger (Boyd, 2001).